Hospital construction and renovation activities are the main cause of healthcare-associated fungal outbreaks. Infection control risk assessments (ICRAs) for renovation and construction decrease the risk of healthcare-associated fungal outbreaks, but they are typically not performed in developing countries. We reviewed an outbreak investigation to limit the construction-related fungal infections in a COVID-19 ICU in a resource-limited setting.

To the Editor-The coronavirus disease 2019 (COVID-19) pandemic is a global healthcare emergency on a scale not seen in more than a century. With the emergence of new variants, COVID-19 is becoming potentially more contagious with transmission dynamics associated with intercontinental spread. 1-4 To limit transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the hospital in Thailand, most hospitals have created special COVID-19-suspected units to care for all patients suspected to have COVID-19. At Thammasat University Hospital (Pratum Thani, Thailand), a COVID-19-suspect unit was created on February 1, 2020. This unit admits non-critically ill medical patients with special protocols (eg, specific laboratory procurement and respiratory sample collection protocol and management of patients by assigned personal for COVID-19) assigned at the initial sites of evaluation (eg, emergency department, outpatient department, emerging infectious diseases clinic) for patients admitted to the COVID-19-suspect unit. From February 1, 2020, to June 30, 2020, higher mortality was detected among patients who were admitted to this unit compared to patients admitted to regular medicine units [10 of 78 (12.8%) vs 46 of 678 (6.7%); P = .04], despite the comparable severity index between those units. The mean Charlson comorbidity index score of COVID-19-suspect unit was 2.2 (±1.7) and this score in regular medicine units was 2.4 (±1.9) (P = .56). We performed a retrospective review of the patients who were admitted to a COVID-19-suspect unit from February through June 30, 2020, to evaluate potential reasons for the higher mortality in this unit. Data collected included patient demographics, underlying diseases, the initial evaluation site (eg, delay laboratory procurements, delay time to admission, and delay in critical medical measures such as intravenous fluid and antibiotic administration), final diagnoses, and causes of mortality. Analyses were performed using SPSS software, version 15 software (IBM, Armonk, NY). Categorical data were compared using the χ 2 test or the Fisher exact test, as appropriate. We used the Mann-Whitney U test to compare continuous variables. Logistic regression was performed to assess predictors for mortality. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were computed; a significant statistical difference was defined as P < .05.

In an intensive care unit, antibiotic heterogeneity led to an increase in antibiotic heterogeneity index (P = .002) and a reduction in carbapenem-resistance Enterobacteriaceae incidence (P = .04). In a general medicine unit with low prevalence of multidrug-resistant organisms, antibiotic heterogeneity index and incidence of multidrug-resistant organisms did not improve.

Mycobacterium scrofulaceum is an environmental mycobacterial species rarely reported to cause disseminated infection in adults. We report the case of a disseminated M. scrofulaceum infection in a 55-year-old nonhuman immunodeficiency virus-infected Thai man with anti-interferon-γ autoantibodies. The clinical signs of the infection improved after the induction regimen with amikacin, rifampicin, ethambutol, and clarithromycin, followed by the consolidation regimen with ethambutol, clarithromycin, and trimethoprim/sulfamethoxazole. Our review of previous reported cases of this infection indicates its association with immune deficiency, complex treatment, and a high rate of unfavorable outcomes.